Decision support systems (DSS) are tools designed to make it easy for health care providers to "do the right thing". I have spent my research career to date developing workflow-sensitive data entry tools, clinical repositories, and DSSs with the ultimate goal of learning how to build and evaluate systems that improve care quality across larger health care enterprises. As a practicing pediatrician, I completed a National Library of Medicine informatics fellowship at the Regenstrief Institute that culminated in completion of a MS in Clinical Research. During this fellowship, I co-developed the Child Health Improvement through Computer Automation (CHICA) system with my primary mentor, Dr. Stephen M. Downs. CHICA is designed to facilitate outpatient pediatric preventive care through a dynamic paper-based, computer-interpretable interface that gathers and distills the most relevant patient data for providers. This DSS has been actively used for direct patient care since November, 2004 in a high-volume pediatric primary care clinic infamous for its resistance to information technology implementations. CHICA contains a number of innovative features which augment steps along the process of preventive service provision through real-time collection of coded historical data. [unreadable] [unreadable] It is the goal of this K22 grant proposal to formally evaluate these adjunctive technologies in a prospective fashion and enhance the underlying infrastructure of the CHICA system to make it suitable for installation in other settings. The results of this work will serve as foundations for a larger randomized controlled trial where I intend to evaluate the system once installed into a larger pediatric practice-based research network. I will complete this work with continued oversight by an internationally recognized academic advisory panel of medical informaticians and health services researchers from the Regenstrief Institute. I fully intend to use this project to acquire additional skills in research techniques, extend these results with further studies, and obtain additional grant funding. It is my long term goal to have this work serve as a further basis for a successful career as an independent researcher and developer of large scale, system-wide clinical decision support systems. [unreadable] [unreadable] [unreadable] [unreadable]